Protecting a patient's airway is the most critical aspect of patient care. The human brain is able to withstand only four minutes of anoxia (lack of oxygen) before suffering irreversible brain damage and, in most cases, death. The preferred method for protecting a patient's airway is to place within the trachea a tube having sufficient rigidity to maintain an open passage between the patient's lungs and the ambient.
In an operating room conditions are ideal for safe, atraumatic endotracheal intubation. The patient is sedated and paralyzed by drugs administered by the anesthesiologist. The position of the patient is ideal. Lighting, equipment, and assistants are also available to help with the intubation. Secretions are controlled with anticholinergic drugs (i.e., agents which decrease oral secretions) and thus do not obstruct visualization of the pathway. The patient is paralyzed by drugs administered prior to the intubation attempts and thus typically does not gag or wretch when a laryngescope blade is inserted down the patient's throat. The patient's stomach is also usually empty in the case of elective surgery, and the possibility of the patient vomiting is thus substantially eliminated.
In emergency medicine, however, a physician, paramedic, or physician assistant is frequently called upon to intubate patients in very undesirable and suboptional working conditions. In an emergency situation, intubation of the trachea is difficult for even the most skilled physician. In the pre-hospital setting, a paramedic is often required to intubate a patient without assistance and in cramped and dark quarters. In an emergency situation, such as cardiopulmonary arrest requiring CPR or a patient who needs intubation while riding in a jostling ambulance, the movement of the patient creates a moving target for the operator. Thus, the circumstances surrounding an emergency intubation greatly complicate the procedure.
The condition of the patient further complicates the emergency endotracheal intubation. When a laryngescope blade is inserted into a semicomatose, non-breathing patient, he or she will frequently wretch, gag, and vomit. Vomitus, oral secretions, and blood must be quickly cleared from the intubator's field of vision and the vocal cords directly visualized to safely and quickly intubate a patient in distress. Improper clearing of secretions increases the risk of aspiration by the patient, and inability to visualize the vocal cords increases the risk of intubation of the esophagus by the operator.
Thus, there is a need for an apparatus which will clear the trachea of unwanted secretions and permit a clear field of view to a physician performing an endotracheal intubation.
To clear the passageway of the presence of oral secretions, vomitus, and blood so that the operator can visualize his reference marks (i.e. the vocal cords) and safely intubate the patient, prior art emergent orotracheal intubation procedures employ a suction device. Typically, the suction device is inserted into the trachea, fluids are aspirated from the field of vision under laryngescopic guidance, the suction device is removed, and an endotracheal tube is inserted. Every second is valuable, and a two step procedure of clearing secretions and then attempting intubation results in lost time. During the time required to suction secretions from the operator's field of vision, remove the suction device, and then grab an endotracheal tube and insert it, the patient may move, or blood, secretions, or vomit may accumulate, obscuring the operator's visualization of the vocal cords.
Thus, there is a need for a method and apparatus which eliminates the delays inherent in prior art procedures whereby the trachea is suctioned with a suction device, the suction device is removed, and an endotracheal tube is subsequently introduced through the trachea.
If an intubation attempt fails, the patient must be preoxygenated and secretions cleared prior to another attempt at intubation. The process of preoxygenating the patient with a bag-mask ventilation device forces air down the trachea as well as down the esophagus into the stomach. When the stomach is distended with air, the patient is more likely to vomit. A distended abdomen also decreases a patient's lung capacity making ventilation more difficult. Further, repeated attempts at intubation causes trauma to the patient, resulting in edema (i.e. swelling) which makes subsequent attempts more difficult. It also increases the chance of aspiration and decreases lung compliance secondary to gastric distention (i.e. filling of the stomach with air).
Thus, there is a need for an apparatus and method which permits secretions to be suctioned from the trachea and intubation to be accomplished accurately, quickly, and consistently on the first attempt so as to obviate the need for repeated preoxygenation and its attendant complications.